What are the recommendations for discontinuing Lumryz (galcanezumab) in a patient who wants to stop taking it?

Discontinuing Lumryz (Sodium Oxybate)

Critical Clarification

I must clarify that "Lumryz" is sodium oxybate for narcolepsy/cataplexy, not galcanezumab (which is used for migraine/cluster headache prevention). The provided evidence discusses galcanezumab extensively but does not contain specific discontinuation protocols for Lumryz (sodium oxybate). However, I will address discontinuation principles based on the available evidence and general medication discontinuation frameworks.

General Discontinuation Approach for Preventive Medications

For patients wishing to discontinue preventive therapies, gradual dose reduction is conditionally recommended over abrupt discontinuation to minimize withdrawal symptoms and monitor for symptom recurrence. 1

Key Discontinuation Principles

• Gradual tapering is preferred over abrupt cessation to allow monitoring for withdrawal effects and disease recurrence 1
• Patients should ideally be at therapeutic target (low disease activity or symptom control) for at least 6 months before considering discontinuation 1
• Dose reduction is conditionally recommended over complete discontinuation as an intermediate step 1

Monitoring During and After Discontinuation

Immediate Post-Discontinuation Period

• Assess patients within 1-2 weeks after each dose reduction to evaluate for withdrawal symptoms including dizziness, vertigo, paresthesias, mood disturbances, insomnia, and gastrointestinal symptoms 2
• Continue monitoring every 2-4 weeks throughout the taper period 2

Extended Monitoring

• Monitor for several months after complete discontinuation, as symptom relapse can occur weeks to months later 2
• Develop a specific monitoring plan to assess whether symptoms return after stopping medication 3
• Watch for return of primary symptoms (in this case, narcolepsy/cataplexy symptoms) 3

Important Safety Considerations

Cardiovascular Monitoring

• Monitor cardiovascular parameters including blood pressure and pulse during discontinuation, as some medications can cause changes in these measures 3

Behavioral and Mood Monitoring

• Watch for mood changes or behavioral symptoms, particularly given potential neuropsychiatric effects 3

Post-Discontinuation Planning

• Document the reason for discontinuation and clinical response to guide future treatment decisions 3
• Consider alternative treatments if discontinuation is due to lack of efficacy rather than adverse effects 3
• Maintain at least one therapeutic agent if the patient has ongoing symptoms to prevent disease progression 1

Common Pitfalls to Avoid

• Do not discontinue abruptly without a tapering plan, as this increases risk of withdrawal symptoms and symptom rebound 1
• Do not assume that short-term symptom control means the medication can be safely stopped—patients should demonstrate sustained control for at least 6 months 1
• Do not fail to establish a monitoring schedule before initiating discontinuation 2, 3